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Our time is up: forced terminations during psychotherapy training
J Q Bostic1, L G Shadid, M J Blotcky
1Harvard Medical School, Massachusetts General Hospital, Boston 02114-3139, USA.
American Journal of Psychotherapy
|January 1, 1996
Summary
Forced therapy terminations impact patients and residents, often triggering past losses and complex emotional responses. Addressing these challenges directly can transform difficult endings into constructive therapeutic opportunities.
Area of Science:
- Psychology
- Psychotherapy
- Clinical Psychology
Background:
- Forced therapy terminations present unique challenges for both patients and therapists (residents).
- These situations can evoke significant emotional reactions, mirroring past losses for patients and complex countertransference for residents.
Observation:
- Patients may exhibit defense mechanisms, symptom changes, and intense reactions to the therapist during forced terminations.
- Residents might display denial, projection, or attempts to alter the therapeutic relationship due to countertransference.
- The intensity of the therapeutic relationship dictates the necessary advance notice for termination.
Findings:
- Careful consideration of patient needs is crucial when deciding what information to disclose before termination.
- Practical aspects like payments, gifts, future contact, and final comments require thoughtful evaluation for the patient's benefit.
- Creative, patient-centered approaches may be necessary, diverging from standard therapeutic practices.
Implications:
- Forced terminations offer a direct avenue to address themes of abandonment, disappointment, and loss within therapy.
- While uncomfortable, these experiences can be therapeutically beneficial if managed with careful consideration and direct engagement.
- Addressing the complexities of forced termination can lead to constructive outcomes for patients and professional growth for residents.